Optimizing treatment sequencing in multiple myeloma: daratumumab upfront versus subsequent lines

Rafael Fonseca, MD, Mayo Clinic, Phoenix, AZ, discusses the findings of a study investigating optimal treatment sequencing in multiple myeloma. With the available options for treatment expanding rapidly, determining the best strategies for upfront treatment and subsequent lines of therapy is of critical importance. In this analysis, the clinical value of daratumumab (DARA) first line compared to later lines was examined in patients with newly diagnosed transplant-ineligible multiple myeloma, since it is unclear where it performs optimally. It was shown that using DARA, lenalidomide, and dexamethasone (D-Rd) first line substantially improved overall survival compared with delaying DARA-based treatment until second line. Due to higher attrition rates in second line and beyond, the results demonstrate that achieving the longest possible progression-free survival in first line is key to optimize overall survival outcomes and therefore, saving DARA to later lines is a suboptimal approach. This interview took place at the 63rd ASH Annual Meeting and Exposition congress in Atlanta, GA.